Provider Demographics
NPI:1689810731
Name:PARRON, JOHN KECKHUT (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:KECKHUT
Last Name:PARRON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:140 BERGEN ST STE D1610
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-2425
Mailing Address - Country:US
Mailing Address - Phone:973-972-3008
Mailing Address - Fax:973-972-9367
Practice Address - Street 1:140 BERGEN ST STE D1610
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2425
Practice Address - Country:US
Practice Address - Phone:973-972-3008
Practice Address - Fax:973-972-9367
Is Sole Proprietor?:No
Enumeration Date:2008-12-19
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT186285207X00000X
NJ25MA09047800207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery